In late December, the Centers for Medicare and Medicaid Services (federal CMS) issued a proposed Medicare Part C and D rule. In partnership with the American Medical Association, the Colorado Medical Society signed onto support these major steps forward in prior authorization reform. As a response to AMA prior authorization survey data and the Office of Inspector General’s 2022 report, we are collectively encouraging finalization of positive changes in prior authorization reform advocacy.

The proposed prior authorization reforms reflect many of the policies for which our organizations have been advocating in the states and at the federal level for many years, including: 

  • Increased clinical validity of coverage criteria;
  • Restrictions on retroactive denials after prior authorization approvals;
  • A grace period for patients switching plans to promote continuity of care;
  • Greater physician-patient autonomy in determining where care can be provided and by whom; 
  • Volume reduction by encouraging gold carding programs; and
  • Prior authorization information at the point-of-care.  

These proposals are not perfect, nor do they have as far of a reach as we would ultimately like, but they are great steps forward in our collective prior authorization reform efforts. The letter to be sent to the federal CMS encourages the agency to apply the prior authorization policies to prescription drugs. We will continue to advocate for reducing administrative burdens on behalf of Colorado physicians and their patients.

Categories: Communications, ASAP